Impact of racialization on neuroimaging and plasma biomarkers of Alzheimer's disease

Jul 9, 2025Alzheimer's & dementia : the journal of the Alzheimer's Association

How racial identity relates to brain scans and blood markers of Alzheimer's disease

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Abstract

Significant differences in biomarker values were observed between 260 older adults racialized as Black and/or African American and non-Hispanic white.

Global Pittsburgh Compound B (PiB) standardized uptake value ratio (SUVR) varied significantly between the two racialized groups.
Cortical thickness measurements also showed notable differences across the groups.
Levels of p-tau181 and p-tau231 differed significantly, suggesting variations in Alzheimer's disease pathology.
These differences were consistent regardless of age, sex, genetic risk factors, education, or cognitive assessment scores.
Racialization may need greater emphasis in Alzheimer's disease clinical research to ensure equitable assessments.

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INTRODUCTION: Given the predominance of imaging and plasma biomarkers in Alzheimer's disease observational studies and clinical trials, it is critical to understand the differences between these biomarkers across racialized groups.

METHODS: A total of 260 older adults without dementia racialized as Black and/or African American (AA) and non-Hispanic white (NHW), ranging in age from 50 to 90 years (68.8 ± 9.1 years), were evaluated for differences in plasma amyloid-β (Aβ) 42/Aβ40, p-tau181, p-tau217, p-tau231, neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP) as well as Aβ positron emission tomography (PET) and magnetic resonance (MR) imaging-derived cortical thickness using Mann-Whitney U tests and analysis of covariance (ANCOVA).

RESULTS: Both Mann-Whitney tests and ANCOVA found significant differences between groups racialized as AA or NWH with respect to global[C]-Pittsburgh Compound B (PiB) standardized uptake value ratio (SUVR), cortical thickness values, p-tau181, and p-tau231 values (p < 0.05). 11

DISCUSSION: Racialization should be given more consideration in AD clinical research, particularly when biomarker results are used for inclusion or exclusion criteria for clinical trials and qualification in clinical practice.

HIGHLIGHTS: Global[C]-Pittsburgh compound B (PiB) standardized uptake value ratio (SUVR), cortical thickness, p-tau181, and p-tau231 differed between groups Differences were unaffected by age, sex, apolipoprotein E 4 (APOE4), education, and Mini-Mental State Examination (MMSE) score Racialization needs more consideration in Alzheimer's disease clinical research Additional work is needed to understand the sources of biomarker differences. 11

Key numbers

2.68

Higher p-tau181 in AA participants

Mean p-tau181 level in AA participants (natural log transformed)

1.17

Higher in NHW participants

Mean in NHW participants (natural log transformed)

65.5

Age difference between groups

Mean age of AA participants in years

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Impact of racialization on neuroimaging and plasma biomarkers of Alzheimer's disease

Abstract

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